Molecular Epidemiologic Characterization of Penicillin-ResistantStreptococcus pneumoniaeInvasive Pediatric Isolates Recovered in Six Latin-American Countries: An Overview

Abstract

The Pan American Health Organization (PAHO) has conducted a study of Streptococcus pneumoniae in six Latin-American countries: Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. Sterile site isolates from children aged < or =5 years showing clinical symptoms of pneumonia (as defined by the clinical criteria of WHO), meningitis, sepsis or bacteremia (without infectious foci), arthritis, and peritonitis were the source of most of the invasive pneumococcal isolates collected between the end of 1993 and 1996 in the six participating countries. Partial characterization of these isolates (antibiotic resistance and serotyping) have already been described (Microbial Drug Resistance 3:(2):131-163, 1997). In the next phase of the study, 326 S. pneumoniae isolates with reduced penicillin susceptibility were transferred to the Laboratory of Microbiology at The Rockefeller University for molecular characterization, and a summary and overview of the findings is described in this article. Some of the most interesting findings were as follows: (1) There was a surprisingly high representation of two internationally spread clones, which made up >80% of the strains with penicillin MIC of 1 microg/ml or higher; most of these isolates were recovered in large cities, supporting the likelihood that the source of these clones is through international travel. (2) The frequency of resistance to trimethoprim/sulfamethoxazole was extremely high (present in 85% of all isolates with decreased penicillin susceptibility). (3) None of these isolates was resistant to ofloxacin, and macrolide resistance was rare (present in 6.4% of the isolates). (4) There was an apparent inverse relationship between level of penicillin resistance and genetic diversity. (5) There were striking differences in the "microbiologic profiles" of the six different Latin-American countries.

Molecular Epidemiology of Pneumococcal Carriage among Children with Upper Respiratory Tract Infections in Hanoi, Vietnam

“…In some countries and populations, up to 60% of the pneumococcal isolates are resistant to one or more antibiotics (1,12,22). A significant proportion of pneumococcal resistance is the result of the worldwide spread of a limited number of multidrug-resistant clones (6,15,35,39).…”

Meeting the challenge: prevention of pneumococcal disease with conjugate vaccines

“…64,65 This suggests that a major part of the antimicrobial resistance within the region is due to the spread of a limited number of pneumococcal clones. 66 …”

Molecular assessment of invasive Streptococcus pneumoniae serotype 1 in Brazil: evidence of clonal replacement

“…Recently, some authors have speculated that isolates of serotype 1, which are known to have a highly invasive potential, behave as primary pathogens, whereas other capsular types demonstrate opportunistic features (Garau & Calbo, 2007;Hausdorff, 2007). Molecular typing studies have greatly contributed to epidemiological investigations of pneumococci, mostly focusing on the global spread of penicillin-resistant clones (Brueggemann et al, 2003;Tomasz et al, 1998). Molecular studies of serotype 1, a usually penicillin-susceptible albeit hypervirulent serotype, have been reported less frequently (Brueggemann & Spratt, 2003;Gonzalez et al, 2004;Normark et al, 2001;Porat et al, 2001).…”

“…Molecular typing studies have greatly contributed to epidemiological investigations of pneumococci, mostly focusing on the global spread of penicillin-resistant clones (Brueggemann et al, 2003;Tomasz et al, 1998). Molecular studies of serotype 1, a usually penicillin-susceptible albeit hypervirulent serotype, have been reported less frequently (Brueggemann & Spratt, 2003;Gonzalez et al, 2004;Normark et al, 2001;Porat et al, 2001).…”